Refractory Central Nervous System Vasculitis and Gastrocnemius Myalgia Syndrome in Crohn's Disease Successfully Treated with Anti-Tumor Necrosis Factor-α Antibody

Ullrich, Sebastian; Schinke, S.; Both, Markus; Knop, Karl Christian; Kirkiles-Smith, Nancy C.; Gross, Wolfgang L.; Lamprecht, Peter

doi:10.1016/j.semarthrit.2008.01.008

Cited by 15 publications

(9 citation statements)

References 55 publications

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“…Using MRI, CAE has been reported to be a common, unrecognised characteristic of patients with systemic vasculitides 8. In this context, CAE is a probable finding in a patient with Crohn’s disease, since Crohn’s disease has been associated with vasculitis affecting large, medium or small-sized vessels 9. In large-sized vessels, the most common vasculitis reported in patients with Crohn’s disease is Takayasu’s arteritis (TA),9 which affects mainly the aorta and its main branches, including the coronary, carotid, pulmonary and renal arteries, leading to stenoses or dilatations of the affected vessels 10.…”

Section: Discussionmentioning

confidence: 99%

“…In this context, CAE is a probable finding in a patient with Crohn’s disease, since Crohn’s disease has been associated with vasculitis affecting large, medium or small-sized vessels 9. In large-sized vessels, the most common vasculitis reported in patients with Crohn’s disease is Takayasu’s arteritis (TA),9 which affects mainly the aorta and its main branches, including the coronary, carotid, pulmonary and renal arteries, leading to stenoses or dilatations of the affected vessels 10. Coronary involvement with aneurysm formation is less common in TA, however several cases have been reported to date 9.…”

Section: Discussionmentioning

confidence: 99%

“…In large-sized vessels, the most common vasculitis reported in patients with Crohn’s disease is Takayasu’s arteritis (TA),9 which affects mainly the aorta and its main branches, including the coronary, carotid, pulmonary and renal arteries, leading to stenoses or dilatations of the affected vessels 10. Coronary involvement with aneurysm formation is less common in TA, however several cases have been reported to date 9. Our patient did not present with acute phase symptoms, or other features suggestive of TA, such as pulse deficits, arterial bruits or an elevated ESR.…”

Section: Discussionmentioning

confidence: 99%

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Coronary artery ectasia in Crohn’s disease

Korovesis¹,

Katritsis

Koudounis

et al. 2018

BMJ Case Reports

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Coronary artery ectasia (CAE) can be ascribed, in the majority of cases, to coronary atherosclerosis. Nevertheless, the presence of isolated ectatic lesions without obstructive coronary artery disease and the association of CAE with several autoimmune diseases characterised by systemic vascular involvement suggest that the pathogenesis of CAE may extend beyond coronary atherosclerosis. We herein report the case of a 56-year-old male patient with Crohn’s disease and isolated CAE, who has been found positive for IgM and IgA antiendothelial cell antibodies, and discuss a potential pathogenic mechanism.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Coronary artery ectasia in Crohn’s disease

Korovesis¹,

Katritsis

Koudounis

et al. 2018

BMJ Case Reports

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“…The extensive detrimental impact of neurological manifestations on a patient’s quality of life makes early diagnosis and treatment particularly important. In previous case-reports, diagnosis of cerebral manifestation in CD often relied upon MRI and CT alone [ 6 – 10 ]. To our knowledge, only one case-report has documented a histologically confirmed case of a cerebral manifestation in CD [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Cerebral granulomatosis as a manifestation of Crohn’s disease

et al. 2018

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BackgroundCrohn’s disease (CD) is associated with a variety of extra-intestinal manifestations. Most commonly these involve the eye, skin, joints, coagulation system and liver. Cerebral manifestations of CD have been reported to a far lesser extent. The extensive detrimental impact of neurological symptoms on a patient’s quality of life makes an early diagnosis and treatment particularly important. In previous case-reports, diagnosis of cerebral manifestations in CD often relied upon magnetic resonance imaging (MRI) and computed tomography (CT) alone. To our knowledge, only one case-report has documented a histologically confirmed case of cerebral lesions associated with CD so far.Case presentationA 39-year-old right-handed woman with a history of CD was referred to our hospital with etiologically unexplained Gadolinium (Gd)-enhancing cortical lesions, triggering epileptic seizures. A CT-scan of the thorax and bronchoalveolar lavage found no signs of sarcoidosis. Lumbar punctures and laboratory testing found no underlying infection or coincidental autoimmune disorders and MRI-scans showed progression of lesion load. Consequently, the patient underwent stereotactic biopsy of a cortical lesion. Histological examination revealed a mixed lympho-histiocytic and tuberculoid granulomatous inflammation surrounding small vessels and no signs for infection. After exclusion of other granulomatous diseases and the typical histological findings we diagnosed a cerebral granulomatosis as a manifestation of CD. The patient was initially started on azathioprine, which had to be switched to corticosteroids and methotrexate because of an azathioprine related pancreatitis. The patient has not suffered any further epileptic seizures to date.ConclusionCerebral manifestation of CD is a possibly underreported entity that may respond well to immunosuppressive treatment. In contrast to earlier reports of cerebral manifestations in CD, our patient showed no coincident gastrointestinal symptoms indicating an activity of CD during the progression of cortical lesion load, suggesting that similar to other extra-intestinal manifestations in CD, the activity of gastrointestinal symptoms does not necessarily reflect the activity of CD associated cerebral vasculitis. Therefore, diagnosis and therapy of cerebral manifestation may be delayed when focusing on gastrointestinal symptoms alone.

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“…Appropriate and prompt diagnosis is often delayed by uncertainties about the relationship of the vasculitis manifestation and CD. [ 2 ] Presentations may include headaches, hemiparesis, and intermittent loss of orientation. [ 3 ] Work-up can reveal elevated inflammatory markers, abnormal cerebral spinal fluid, and magnetic resonance imaging (MRI) abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Crohns disease with central nervous system vasculitis causing subarachnoid hemorrhage due to aneurysm and cerebral ischemic stroke

Garge

Vyas

Modi

et al. 2014

Ann Indian Acad Neurol

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Cerebral vasculitis secondary to Crohn's disease (CD) seems to be a very rare phenomenon. We report a 39-year-old male who presented with headache, vomiting, and left-sided weakness in the known case of CD. Cross-sectional imaging (computed tomography and magnetic resonance imaging,) showed right gangliocapsular acute infarct with supraclinoid cistern subarachnoid hemorrhage (SAH). Cerebral digital substraction angiography (DSA) showed dilatation and narrowing of right distal internal carotid artery (ICA). Left ICA was chronically occluded. His inflammatory markers were significantly raised. Imaging features are suggestive of cerebral vasculitis. Arterial and venous infarcts due to thrombosis are known in CD. Our case presented with acute subarachnoid hemorrhage in supraclinoid cistern due to rupture of tiny aneurysm of perforator arteries causing SAH and infarction in right basal ganglia. Patient was treated conservatively with immunosuppression along with medical management of SAH.

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Refractory Central Nervous System Vasculitis and Gastrocnemius Myalgia Syndrome in Crohn's Disease Successfully Treated with Anti-Tumor Necrosis Factor-α Antibody

Cited by 15 publications

References 55 publications

Coronary artery ectasia in Crohn’s disease

Coronary artery ectasia in Crohn’s disease

Cerebral granulomatosis as a manifestation of Crohn’s disease

Crohns disease with central nervous system vasculitis causing subarachnoid hemorrhage due to aneurysm and cerebral ischemic stroke

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